Towards a biopsychosocial explanation of headache in patients with tumors of the sellar region : the role of personality, stress coping and pain catastrophizing

Background. It was the aim of the present thesis to investigate the influence of a psychological component on the occurrence of headache, disability due to headache and treatment response of headache to neurosurgery in patients with tumors of the sellar region (TSR). With an observed prevalence of up to 70% headache is a common symptom in patients with TSR. It has previously been entirely attributed to pathophysiological mechanisms. Earlier studies investigated mechanical pressure due to tumor size, intrasellar pressure and endocrine hypersecretion as possible causes for pain, but the results stayed largely inconclusive. The present thesis is the first to introduce a biopsychosocial model to the explanation of headache in patients with TSR.

Methods. 112 patients with TSR prior to first-time neurosurgery received questionnaires on personality (NEO Five-Factor Inventory, NEO-FFI), headache characteristics (Essen Headache Inventory, EHI) and disability due to headache (Migraine Disability Assessment, MIDAS). A subsample of 71 patients was additionally questioned on stress coping (BriefCOPE) and pain catastrophizing (Pain Catastrophizing Scale, PCS). Headache characteristics in 68 patients were assessed for a second time on average 7.1 months after neurosurgery. Occurrence of headache within the last three months and disability due to headache as indicated by the MIDAS score were used as criteria variables in logistic regression models. Change in MIDAS score after neurosurgery was correlated to potential psychological influencing factors.

Results. Logistic regression analyses revealed that conscientiousness, neuroticism and pain catastrophizing were significant predictors of headache occurrence, whereas neuroticism, pain catastrophizing and humor predicted disability due to headache. There was no significant effect of neurosurgery on the occurrence of headache. Disability due to headache was not significantly reduced after neurosurgery, either. Individual change in disability due to headache after neurosurgery correlated positively to extraversion and negatively to neuroticism, behavioral disengagement and humor.

Discussion. The results clearly support the theory of a psychological influence on headache in patients with TSR. They suggest that physicians involved in the clinical treatment of TSR should refrain from purely mechanistic explanations of headache. They also lend further strength to the argument, that neurosurgery should not be performed due to headache alone and integrative treatment approaches for headache in patients with TSR should be considered. The derived biopsychosocial model raises a multitude of further research questions, which could help to elucidate the as yet unclear specifics of the causation of headache in patients with TSR.


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